Structured Data Capture
4.0.0 - STU 4 International flag

Structured Data Capture, published by HL7 International / FHIR Infrastructure. This guide is not an authorized publication; it is the continuous build for version 4.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/sdc/ and changes regularly. See the Directory of published versions

Questionnaire:

Official URL: http://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-render Version: 4.0.0
Standards status: Informative Active as of 2026-03-24 Computable Name: SDCAdvancedRenderingExample
Other Identifiers: OID:2.16.840.1.113883.4.642.40.17.35.16

Structure
LinkIDTextCardinalityTypeFlagsDescription & Constraintsdoco
.. SDCAdvancedRenderingExample Questionnaire http://build.fhir.org/ig/HL7/sdc/questionnaire-sdc-profile-example-render#4.0.0
... 1 Text Appearance 0..1 group Value Set:
.... 1.1 Enter your First Name 0..1 string Value Set:
.... 1.2 Please answer Yes or No to each of the following questions: 0..1 display Value Set:
.... 1.2b Please answer Yes or No to each of the following questions: 0..1 display Value Set:
.... 1.3 ALL QUESTIONS CONTAINED IN THIS QUESTIONNAIRE ARE OPTIONAL AND WILL BE KEPT STRICTLY CONFIDENTIAL. 0..1 display iconicon Value Set:
.... 1.4 null 0..1 group Value Set:
..... 1.4.1 Form ID 0..1 string iconicon Value Set:
..... 1.4.2 Event ID 0..1 string Value Set:
... 2 Control Appearance 0..1 group Value Set:
.... 2.1 If you have any other medical problems or serious injuries, please describe them here: 0..1 text Value Set:
.... 2.2 Gender: 0..1 choice iconicon Value Set:
Options: 4 options
.... 2.3 Rate your doctor: 0..1 integer Value Set:
Initial Value: integer = 50
..... 2.3.1 Completely dissatisfied 0..1 display Value Set:
..... 2.3.2 Completely satisfied 0..1 display Value Set:
.... 2.4 Medical History 0..1 group Value Set:
..... 2.4.1 Diabetes 0..1 choice Value Set:
Options: 2 options
..... 2.4.2 Other Information 0..1 choice Value Set:
Options: 4 options
.... 2.5 null 0..1 group Value Set:
..... 2.5.1 Relationship to patient 0..1 choice Value Set:
Options: 3 options
..... 2.5.2 Name 0..1 string Value Set:
..... 2.5.3 Gender 0..1 choice Value Set:
Options: 4 options
.... 2.6 Lifestyle Factors 0..1 group Value Set:
..... 2.6.1 Exercise Habits 0..1 choice Value Set:
Options: 4 options
..... 2.6.2 Smoking Frequency 0..1 choice Value Set:
Options: 4 options
..... 2.6.3 Alcohol Consumption 0..1 choice Value Set:
Options: 4 options
... 3 Additional Display Content 0..1 group Value Set:
.... 3.1 Have you traveled outside the country within the last 14 days? 0..1 choice Value Set:
Options: 2 options
.... 3.2 Select Platelet: 0..1 choice Value Set: LOINC Answer Codes for LL715-4
.... 3.3 Gender: 0..1 choice Value Set:
Options: 4 options
.... 3.4 Enter timing of harm assessment: 0..1 choice iconicon Value Set: Timing of harm assessment [AHRQ]
.... 3.5 Birth Date 0..1 date Value Set:
.... 3.6 IMPORTANT: Please complete questionnaire. 0..1 display Value Set:
.... 3.7 Enter your Middle Name 0..1 string iconicon Value Set:
.... 3.8 During the past year, what was the total combined income for you and the family members you live with? This information will help us determine if you are eligible for any benefits. 0..1 decimal Value Set:
.... 3.9 Which of the following time-slots are you available for? 0..1 string Value Set:
Options: 6 options
.... 3.10 Select a condition (terminology server: tx.fhir.org) 0..1 choice Value Set: All Codes SCT ValueSet

doco Documentation for this format

Options Sets

Answer options for 2.2

  • http://hl7.org/fhir/administrative-gender#female ("Female")
  • http://hl7.org/fhir/administrative-gender#male ("Male")
  • http://hl7.org/fhir/administrative-gender#other ("Other")
  • http://hl7.org/fhir/administrative-gender#unknown ("Unknown")

Answer options for 2.4.1

  • http://example.org/CodeSystem/conditions#diabetes-type1 ("Type 1")
  • http://example.org/CodeSystem/conditions#diabetes-type2 ("Type 2")

Answer options for 2.4.2

  • http://example.org/CodeSystem/conditions#diabetes-type1 ("Type 1")
  • http://example.org/CodeSystem/conditions#diabetes-type2 ("Type 2")
  • http://example.org/CodeSystem/conditions#otherinformation-hypertension ("Hypertension")
  • http://example.org/CodeSystem/conditions#otherinformation-smoker ("Smoker")

Answer options for 2.5.1

  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#FTH ("Father")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#MTH ("Mother")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#SIB ("Sibling")

Answer options for 2.5.3

  • http://hl7.org/fhir/administrative-gender#female ("Female")
  • http://hl7.org/fhir/administrative-gender#male ("Male")
  • http://hl7.org/fhir/administrative-gender#other ("Other")
  • http://hl7.org/fhir/administrative-gender#unknown ("Unknown")

Answer options for 2.6.1

  • http://example.org/CodeSystem/lifestyle#daily ("Daily")
  • http://example.org/CodeSystem/lifestyle#weekly ("Weekly")
  • http://example.org/CodeSystem/lifestyle#monthly ("Monthly")
  • http://example.org/CodeSystem/lifestyle#never ("Never")

Answer options for 2.6.2

  • http://example.org/CodeSystem/lifestyle#daily ("Daily")
  • http://example.org/CodeSystem/lifestyle#weekly ("Weekly")
  • http://example.org/CodeSystem/lifestyle#monthly ("Monthly")
  • http://example.org/CodeSystem/lifestyle#never ("Never")

Answer options for 2.6.3

  • http://example.org/CodeSystem/lifestyle#daily ("Daily")
  • http://example.org/CodeSystem/lifestyle#weekly ("Weekly")
  • http://example.org/CodeSystem/lifestyle#monthly ("Monthly")
  • http://example.org/CodeSystem/lifestyle#never ("Never")

Answer options for 3.1

  • http://terminology.hl7.org/CodeSystem/v2-0532#Y ("Yes")
  • http://terminology.hl7.org/CodeSystem/v2-0532#N ("No")

Answer options for 3.3

  • http://hl7.org/fhir/administrative-gender#female ("Female")
  • http://hl7.org/fhir/administrative-gender#male ("Male")
  • http://hl7.org/fhir/administrative-gender#other ("Other")
  • http://hl7.org/fhir/administrative-gender#unknown ("Unknown")

Answer options for 3.9

  • 9-10am
  • 10-11am
  • 11am-12pm
  • 1-2pm
  • 2-3pm
  • 3-4pm

Text Appearance

  • linkId: 1
  • Answers:

Enter your First Name

  • linkId: 1.1
  • Answers:

Please answer Yes or No to each of the following questions:

  • linkId: 1.2
  • Answers:

Please answer Yes or No to each of the following questions:

  • linkId: 1.2b
  • Answers:

ALL QUESTIONS CONTAINED IN THIS QUESTIONNAIRE ARE OPTIONAL AND WILL BE KEPT STRICTLY CONFIDENTIAL.

  • Flags: icon
  • linkId: 1.3
  • Answers:

  • linkId: 1.4
  • Answers:

Form ID

  • Flags: icon
  • linkId: 1.4.1
  • Answers:

Event ID

  • linkId: 1.4.2
  • Answers:

Control Appearance

  • linkId: 2
  • Answers:

If you have any other medical problems or serious injuries, please describe them here:

  • linkId: 2.1
  • Answers:

Gender:

Rate your doctor:

  • linkId: 2.3
  • Answers:
  • Initial Values: 50

Completely dissatisfied

  • linkId: 2.3.1
  • Answers:

Completely satisfied

  • linkId: 2.3.2
  • Answers:

Medical History

  • linkId: 2.4
  • Answers:

Diabetes

Other Information

  • linkId: 2.5
  • Answers:

Relationship to patient

Name

  • linkId: 2.5.2
  • Answers:

Gender

Lifestyle Factors

  • linkId: 2.6
  • Answers:

Exercise Habits

Smoking Frequency

Alcohol Consumption

Additional Display Content

  • linkId: 3
  • Answers:

Have you traveled outside the country within the last 14 days?

Select Platelet:

Gender:

Enter timing of harm assessment:

Birth Date

  • linkId: 3.5
  • Answers:

IMPORTANT: Please complete questionnaire.

  • linkId: 3.6
  • Answers:

Enter your Middle Name

  • Flags: icon
  • linkId: 3.7
  • Answers:

During the past year, what was the total combined income for you and the family members you live with? This information will help us determine if you are eligible for any benefits.

  • linkId: 3.8
  • Answers:

Which of the following time-slots are you available for?

Select a condition (terminology server: tx.fhir.org)

LinkIDDescription & Constraintsdoco
.. 1 Value Set:
... 1.1 Value Set:
... 1.2 Value Set:
... 1.2b Value Set:
... 1.4 Value Set:
.... 1.4.1 Value Set:
.... 1.4.2 Value Set:
.. 2 Value Set:
... 2.1 Value Set:
... 2.2 Value Set:
Options: 4 options
... 2.3 Value Set:
Initial Value: integer = 50
.... 2.3.1 Value Set:
.... 2.3.2 Value Set:
... 2.4 Value Set:
.... 2.4.1 Value Set:
Options: 2 options
.... 2.4.2 Value Set:
Options: 4 options
... 2.5 Value Set:
.... 2.5.1 Value Set:
Options: 3 options
.... 2.5.2 Value Set:
.... 2.5.3 Value Set:
Options: 4 options
... 2.6 Value Set:
.... 2.6.1 Value Set:
Options: 4 options
.... 2.6.2 Value Set:
Options: 4 options
.... 2.6.3 Value Set:
Options: 4 options
.. 3 Value Set:
... 3.1 Value Set:
Options: 2 options
... 3.2 Value Set: LOINC Answer Codes for LL715-4
... 3.3 Value Set:
Options: 4 options
... 3.4 Value Set: Timing of harm assessment [AHRQ]
... 3.5 Value Set:
... 3.6 Value Set:
... 3.7 Value Set:
... 3.8 Value Set:
... 3.9 Value Set:
Options: 6 options
... 3.10 Value Set: All Codes SCT ValueSet

doco Documentation for this format

Contained resources

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire

There are currently no QuestionnaireResponse instances for this Questionnaire defined in this IG.